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[Intracranial pressure in comatose meningitis and encephalitis in children]
P Rebaud1, J C Berthier, E Hartemann
1Service de pédiatrie, Centre hospitalier Lyon-Sud, Pierre-Bénite, France.
Insights
Intracranial hypertension is common in children with severe meningitis or encephalitis. Monitoring intracranial pressure (ICP) is crucial for comatose patients, especially those with bacterial meningitis or severe encephalitis, to improve outcomes.
Area of Science:
- Neurology
- Pediatrics
- Critical Care Medicine
Context:
- Central nervous system infections like meningitis and encephalitis can lead to severe neurological compromise in children.
- Deep coma (Glasgow Coma Scale ≤7) in pediatric patients necessitates evaluation for intracranial pressure (ICP) elevation.
Purpose:
- To investigate the significance of intracranial hypertension in pediatric patients diagnosed with acute central nervous system infections.
- To correlate ICP levels with clinical outcomes, including survival and neurological status.
Summary:
- A study of 27 comatose children (45 days to 13 years) with meningitis or encephalitis revealed high incidences of intracranial hypertension (ICP >15 mm Hg).
- Meningitis cases showed early and severe ICP elevation (86%), while encephalitis cases showed 69% incidence.
- Non-survivors experienced higher maximal ICP and reduced cerebral perfusion pressure, highlighting ICP's critical role.
Impact:
- ICP monitoring is vital for comatose pediatric patients with bacterial meningitis, herpes encephalitis, and post-infectious encephalitis with status epilepticus.
- Findings underscore the importance of early ICP assessment and management in severe pediatric CNS infections to potentially improve patient prognosis.
Abstract:
To determine the importance of intracranial hypertension in central nervous system acute infections, we studied intracranial pressure (ICP) in 27 patients, aged 45 days to 13 years. Fourteen had meningitis and 13 had encephalitis; all were in deep coma with a Glasgow Coma Scale 7 or less. Intracranial hypertension defined by a mean ICP above 15 mm Hg was observed in 12 patients with meningitis (86%) and in 9 with encephalitis (69%). Patients with meningitis exhibited a very early and severe intracranial hypertension. A striking difference is noted between survivors and non-survivors who had a very high maximal ICP with a severe reduction in cerebral perfusion pressure. Intracranial hypertension occurred in all patients with acute primitive encephalitis but only in 3/7 patients with post-infectious encephalitis. ICP monitoring seems to be important in the comatose forms of bacterial meningitis in the early period, herpes encephalitis and postinfectious encephalitis with severe status epilepticus.